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  By Frank M. Painter, D.C. in Documentation on June 18th, 2013 at 12:57 pm
MEDICARE INFO: Cross-Referencing Regions of Complaint,
PART Findings, Diagnoses and CPT Codes
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By K. Jeffrey Miller, DC, DABCO
In 2012 the Centers for Medicare and Medicaid Services and CMS-contracted reviewers performed chiropractic Medicare reviews nationwide. The results of their efforts were not good news for the chiropractic profession.
The reviews pointed to poor record-keeping and billing practices throughout the profession. Claims were also made of inappropriate billing of maintenance care resulting in significant overpayments for chiropractic services. [1] Unfortunately, these findings were consistent with previous CMS chiropractic reviews. [2]
Of the current review findings, the one that is most disappointing is our consistency from one CMS review to the next. It is difficult to respond to our many Medicare problems all at once. It can be overwhelming. However, while we cannot fix everything at once, we can fix something.
There are a specific set of closely related problems that can and should be addressed together. In actuality, the problems are so intertwined that they are really a single concern: matching the number of symptomatic spinal / pelvic regions; the number of spinal /pelvic regions with PART and/or X-ray findings of subluxation; the number of diagnoses, the number of regions adjusted; and the CPT code used to bill for the adjustment.
Volumes have already been written about this concern. Here, I offer a set of questions to help guide doctors in documenting the number of patient complaints, subluxations, diagnoses, regions adjusted and the appropriate billing codes. This series of questions is accompanied by comments and tables to clarify the importance of each question.
Questions to Ask Yourself After Examining a Medicare Patient
- How many regions of the spine / pelvis did the patient list as painful or symptomatic? Medicare is not purely subluxation based, despite the original and lasting rule that a subluxation must be documented in any region adjusted. The diagnostic criteria also require a symptom code for each region of subluxation. With this in mind, Medicare assumes the patient to have a complaint in each region treated and that the patient reported these complaints during their history. This is a common expectation for many other carriers as well. Carriers do not feel treatment of a region that is asymptomatic is necessary. “Asymptomatic” for Medicare and many other carriers translates to “no problem or no condition.”
Continue reading …
By Frank M. Painter, D.C. in Announcement on June 16th, 2013 at 2:07 pm
Happy Father’s Day!
The Chiro.Org Blog
Happy Father’s Day
to Chiropractic Fathers,
wherever you may be!
Chiropractic Research: A Moral Issue
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic ~ June 1, 2013
By Stephen M. Perle, DC, MS
This year I’ve had the opportunity to go to three great chiropractic research conferences; the Association of Chiropractic Colleges / Research Agenda Conference (ACC-RAC), the Fédération Internationale de Chiropratique du Sport (FICS) Congress and the World Federation of Chiropractic Congress. Seeing the wide range of both basic and clinical-science research made me proud to be a doctor of chiropractic.
In my time in the profession I’ve witnessed amazing progress in the state of chiropractic research. A little over 30 years ago I was a research assistant at Texas Chiropractic College. Our new research director at the time, Dr. Jay Simon, asked me to search for what research there was about chiropractic and manipulation. Hours in the library at TCC, Baylor Medical College and the Texas College of Osteopathic Medicine resulted in less original research than I saw and heard at these three conferences. I think the body of research is expanding in ways that will positively impact our management of patients.
This research is leading to a real Golden Age for our profession despite the battles we need to fight – and maybe because of them. I have worked with the American Chiropractic Association in helping reverse the decisions of a few insurance carriers that intended to discontinue coverage for certain conditions treated by chiropractic physicians. The reversal of those policy changes was based entirely on seeing the scientific evidence that demonstrated the safety and efficacy of our care.
We know so much more about the effects and clinical and cost-effectiveness of our interventions than I dreamed of while sitting in those libraries digging away to find any evidence. Yet despite being a research assistant in chiropractic college back then, I never really saw how research was going to benefit our patients, profession or me when I started my practice in 1983.
Continue reading …
By Steve Vaitl in Education on June 9th, 2013 at 10:07 am
HSPH-HMS214X Fundamentals of Clinical Trials is just one of the courses offered at www.edx.org.
Ever wonder what it would be like to take a course offered at an Ivy League University? Wonder no more! Harvard is part of a consortium of the most prestigious Universities in the world that is offering MOOC‘s (Massive Open Online Courses). There are no costs involved in taking a MOOC and you get all the same information that you would in an on ground course. The only differences are that you don’t get the instructor (or even TA’s) grading your papers nor will you get college credit on a transcript from Harvard. They are however the same information used in the universities’ on ground for-credit courses that can cost thousands of dollars.
MOOC’s typically use open source materials (available at no charge for personal use) and a type of self grading system based off of discussion forums in the course (It is totally up to the professor how that is handled, so it will vary depending on the course and instructor). They are a combination of one answer to cutting high educational and making it available to everyone.
The course begins October 14, 2013, runs a total of 13 weeks and depending on your background will take between 4-6 hours of your time each week. A background in biostatistics and epidemiology equivalent to the content of PH207X Health in Numbers: Quantitative Methods in Clinical & Public Health Research.
From the course site;
“This course will provide an introduction to the scientific, statistical, and ethical aspects of clinical trials research. Topics include the design, implementation, and analysis of trials, including first-in-human studies (dose-finding, safety, proof of concept, and Phase I), Phase II, Phase III, and Phase IV studies. All aspects of the development of a study protocol will be addressed, including criteria for the selection of participants, treatments, and endpoints, randomization procedures, sample size determination, data analysis, and study interpretation. The ethical issues that arise at each phase of therapy development will be explored.”
By John in News on June 4th, 2013 at 3:07 pm
Source The Plain Dealer
By Brandon Blackwell, The Plain Dealer
COLUMBUS, Ohio – Some Ohio physicians are upset over a budget provision that would allow chiropractors to make the calls on putting student athletes with head injuries back in the game.
Senate lawmakers on Thursday are likely to pass a version of the budget, House Bill 59, that gives chiropractors the authority to clear the return of young athletes who are taken off the field for symptoms of a concussion or head injury. The move has upset those who say chiropractors do not have the proper training to handle the responsibility.
“I think that when we’re talking about serious head injuries to children, a physician’s training and scope of expertise is broader and more comprehensive than a chiropractor,” said Tim Maglione, senior director of the Ohio State Medical Association. “Chiropractors have a role in the continuum of care for athletes. We just don’t think it should go as far as assessing head injuries for young children.”
Supporters of the provision, however, say chiropractors receive rigorous training in neurology and are well qualified to make the assessments.
Current law gives doctors of medicine or osteopathic medicine the authority to clear a young athlete for a return to sports. The amendment would extend that authority to chiropractors.
Maglione sent a letter last month to the Senate asking lawmakers to toss the provision.
“The simple fact is that physicians are granted ultimate oversight…because they are best equipped in terms of education and training to act in that role,” Maglione said in the letter. “Those without adequate education and training should not be making return to play decisions independently.
“The training and education of a physician is vastly different and indeed more rigorous than that required for a chiropractor.”
The letter included signatures from officials with the Ohio Chapter of the American Academy of Pediatrics, Ohio Children’s Hospital Association, Ohio Athletic Trainers Association, Ohio Hospital Association and the Ohio Osteopathic Association.
Continue reading …
By Frank M. Painter, D.C. in Announcement on May 30th, 2013 at 10:47 pm
We Are Tough And Ornery
The Chiro.Org Blog
For the second month in a row we were knocked offline for 12 or more hours, first by a computer malfunction, and yesterday by an upline network blow-out.
We’ve been doing what we do for more than 18 years, and we have virtually no overhead costs, since everyone’s a volunteer doctor. So, if you ever see us missing, it’s only a technical problem, it’s NOT that we’ve given up the job.
We’re here to stay, and we expect you to stand your ground and stick with us. No other chiropractic information site comes close to what we do, and we’re here to stay. That’s because We Are Tough And Ornery, and we love what we do, and we know that you love it too!
By Frank M. Painter, D.C. in Cervical Spine on May 27th, 2013 at 11:35 am
Specific Potentialities of the Subluxation Complex
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 7 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 7: Specific Potentialities of the Subluxation Complex
This chapter describes the primary neurologic implications of subluxation syndromes, either as a primary factor or secondary to trauma or pathology, within the cervical spine, thoracic spine, lumbar spine, and pelvic articulations.
GENERAL CONSIDERATIONS
Studies reported by Drum, Hargrave-Wilson, Kunert, Burke, Gayral/Neuwirth, and others have shown that a subluxation complex, often leading to spondylosis, can effect a wide variety of disturbances that may appear to be disrelated on the surface. Most of the remote effects can be grouped under the general classifications of nerve root neuropathy, basilar venous congestion, cervical autonomic disturbances, CSF pressure and flow disturbances, axoplasmic flow blocks, irritation of the recurrent meningeal nerve, the Barre-Lieou syndrome, and/or the vertebral artery syndrome.
This chapter describes many causes for and effects of a spinal subluxation complex. In clinical practice, however, causes and effects are rarely found as isolated entities. Several factors will usually be involved and superimposed on each other.
Innervation of the Spinal Dura
It has long been known that the spinal dura mater has an intrinsic nerve supply. Spinal meningeal rami are derived from gray communicating rami and spinal nerves. The spinal nerves contribute sensory fibers to the meningeal rami. Several meningeal rami enter each IVF, and most are located anteriorly to the sensory ganglia within the IVF.
Bridge found that these intrinsic nerve fibers reach the anterior surface of the dura by three main courses. Here the nerves divide into ascending and usually longer descending filaments that run longitudinally and parallel on the dural surface, and a considerable amount of nerve overlaps from adjacent segments. Finer filaments penetrate the dural substance where they subdivide.
Kimmel reported that most of these fibers penetrate the dura near the midline, while others enter laterally near the exiting spinal nerve roots. At each segment level, two or three nerves enter the spinal dura mater and contain only small nerve fibers. In contrast, Edgar/Nundy could determine no definitive nerve endings, but the nerves could be traced to the posterior aspect of the spinal dura. These observations help to clarify the wide distribution of back pain that is often found following protrusion of a single IVD.
Cervical Dura Attachments
Sunderland states that the nerve sheaths in the cervical region are not firmly attached to their respective foramina. Only the C4 C6 cervical nerves have a strong attachment to the vertebral column, and this is to the gutter of the vertebral transverse process. He believes that these observations have relevance to any local lesion that may fix, deform, or otherwise affect the nerve and its roots to the point of interfering with their function, and they also may be important to traction injuries of nerve roots.
Continue reading …
By John in Video on May 26th, 2013 at 12:44 pm
By Frank M. Painter, D.C. in Announcement on May 25th, 2013 at 2:58 pm
The Bivouac of the Dead
The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;
On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.
Continue reading …
By Frank M. Painter, D.C. in Documentation on May 25th, 2013 at 12:14 pm
SOAP Notes: A Chiropractic Perspective
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic ~ March 1, 2013,
By Ronald Short, DC, MCS-P
S.O.A.P: We all learned it in school and we all do our best to follow it in our daily charting of patient encounters. My good friend Dr. Mario Fucinari expresses it as a formula:
S+O=A yields P.
Your subjective findings plus your objective observations equal your assessment, which leads to your plan. Simple. Easy to understand.
The important thing to remember regarding the SOAP is that it was designed for the practice style of a medical doctor. To illustrate this, let’s assume a scenario. You are working in your garden, clearing under a rose bush, when you are startled by a small snake. You reflexively jerk your arm back and cut your forearm on one of those monstrous thorns that reside at the base of the rose bush. You now are the proud owner of a 4-inch gash on your forearm. You know you should go inside, and clean and bandage it, but you are nearly done and it is getting dark, so you blot it with a towel (that isn’t too dirty) and keep working.
Two days later, your forearm is swollen, red, painful, and hot to the touch. You go to your MD and tell them of your gardening misadventure. This is the subjective portion of the encounter. The doctor then examines your arm, noting the redness and swelling, and how you flinch when they instinctively touch the sorest point on your arm. They order a CBC and note an elevated white count. This is the objective portion of the encounter.
The doctor determines that you have an infection. This is their assessment. They write you a prescription for a course of amoxicillin and tell you to take four pills each day for the next 10 days, and to come back if the arm gets worse or if the pain, swelling, and redness are not gone by the time the pills are gone. This is their plan.
You take the prescription to your pharmacy and purchase 40 units of therapy, which you take home and self-administer. By the time the pills are gone the pain and swelling are nothing more than a bad memory. You are done and the whole episode lasted less than two weeks. This is how a medical doctor practices.
Chiropractors practice similarly, but with a few significant differences. When you jerked away from the snake, you felt a “pop” in your low back and the pain has been getting progressively worse and has started to radiate down your right leg. You go to your chiropractor and tell them of your gardening misadventure, and that the pain is getting worse and radiating down your right leg. This is the subjective portion of the encounter and is essentially the same as it was with the medical doctor.
You may also want to review our article:
What is Medical Necessity?
as it reviews SOAP Notes in depth.
Continue reading …
By John in Health on May 21st, 2013 at 4:44 pm
Source NY Times
Fiscal Policy can be a Matter of Life or Death
In their new book, “The Body Economic: Why Austerity Kills,” economist David Stuckler and physician Sanjay Basu examine the health impacts of austerity across the globe. The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis. For example, in Greece, where spending on public health has been slashed by 40 percent, HIV rates have jumped 200 percent, and the country has seen its first malaria outbreak since the 1970s. An economist and public health specialist, Stuckler is a senior research leader at Oxford University. Dr. Basu is a physician and epidemiologist who teaches at The authors estimate there have been more than 10,000 additional suicides and up to a million extra cases of depression across Europe and the United States since governments started introducing austerity programs in the aftermath of the economic crisis.
If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity.
Continue reading …
By Frank M. Painter, D.C. in Documentation on May 17th, 2013 at 1:10 pm
SOAP Notes: Is It Time for a Cleaning?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic – May 15, 2013
By James Edwards, DC
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
But Dr. Ronald Short beat me to the punch with his outstanding article:
“SOAP: A Chiropractic Perspective” [March 1, 2013 issue], in which he masterfully illustrated the problem. Hopefully, claim reviewers and documentation gurus will finally realize the difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit.
As Dr. Short so ably pointed out, to require orthopedic and neurological testing on each chiropractic visit is the equivalent of requiring a medical doctor to perform blood tests after each antibiotic pill. I could not have said it better myself.
It is important to remember that doctors of chiropractic are unique because we wear two very different hats. First, we are physicians who examine and diagnose (assessment) the patient. Then, after doing so, we carry out our treatment plan by providing care (treatment) to the patient. Failing to realize the distinct difference between a chiropractic “assessment” visit and a chiropractic “treatment” visit places undue, unfair and unnecessary examination and documentation requirements on doctors of chiropractic, and it is time for it to stop.
This problem has been known for years, yet no one has been successful in sensitizing the chiropractic “powers that be” about this unfairness. The American Chiropractic Association’s Clinical Documentation Committee, during the process of authoring the third edition of the ACA Clinical Documentation Manual, attempted to directly address the issue by approving and submitting the following provision:
You may also want to review our article:
What is Medical Necessity?
as it reviews SOAP Notes in depth.
It is important to understand that the chiropractic physician has two responsibilities to their patients.
Continue reading …
A Comprehensive Review of Chiropractic Research
The Chiro.Org Blog
SOURCE: Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC
By Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC
Director of Research and Education for the Foundation for Chiropractic Education and Research (FCER) until its demise (1992-2007), and the current Director of Research at International College of Applied Kinesiology (USA).
I. Introduction
A. Perspectives:
In the space of just 115 years from its inception, chiropractic has emerged as the third largest healthcare profession in the United States offering diagnostic as well as therapeutic services to patients. It has reached this lofty height driven by research which has made particularly dramatic strides over the past 30 years, supported by a budget which represents merely an infinitesimal fraction of that applied to medical and pharmaceutical research.
Like all health professions, chiropractic regularly tests the effectiveness, safety, and costs of its approaching health care. Studies continue to show that chiropractors offer the public a viable alternative to invasive healthcare (drugs, surgery) especially in the treatment of musculoskeletal problems such as back, neck, and headache pain. But chiropractic treatments are likewise effective in the treatment of non-musculoskeletal health issues, including infantile colic, enuresis, asthma, dysmenorrheal, otitis media, hypertension, and heart rate variability. And few medical professions outside of chiropractic can offer such healthcare solutions with equal safety and cost records.
Having been historically been placed in the category of “alternative and complementary” medicine, chiropractic because of its rapid growth in its research has now been deemed to have reached the crossroads of mainstream and alternative medicine. [1] As a hybrid, it appears to have successfully incorporated many of the research methodologies of orthodox medicine while striving to maintain its distinct healthcare paradigm. Indeed, when the practitioner’s primary means of patient care and published randomized clinical trials supporting that intervention are matched, chiropractic can be shown to enjoy a higher percentage of interventions thus supported when compared to such other medical disciplines as general practice, inpatient general surgery, dermatology, or hematology-oncology. [2] In other words, chiropractic can now claim to have attained at least as much of a scientific grounding as other medical interventions based upon its research.
So what is it that one means by chiropractic research? The research related to the practice of chiropractic, to be reviewed in this chapter, has been presented in multiple dimensions, including:
1. Published clinical articles;
2. Literature reviews;
3. Surveys and public opinion research;
4. Analyses of insurance claims [actuarial research];
5. Guidelines
B. First major interdisciplinary cohort study:
One of the first lines of evidence in support of chiropractic intervention that could be considered to be more robust came in 1985 from a prospective observational study of 283 patients suffering from chronic low back and leg pain, drawn from a university back pain clinic reserved for patients who had not responded to previous conservative or operative treatment. Given a 2-3 week regimen of daily spinal manipulation by an experienced chiropractor, 81% of these patients with referred pain and 48% of those with nerve compression displayed improvements in pain grades after their assessments at 1 month followed by 3-month intervals. The research was noteworthy in that it represented a collaboration between chiropractic [David Cassidy] and medical providers [William Kirkaldy-Willis] and was published in a leading medical journal. [3]
Continue reading …
Get the Lead Out!
The Chiro.Org Blog
SOURCE: MedPage Today ~ May 13, 2013
By Nancy Walsh, Staff Writer, MedPage Today
When the FDA finally got around to testing 324 multivitamin-mineral products that target children and pregnant women, they found that only 4 of them were lead-free. [1]
Now, new research published in the Pediatrics Journal suggests that even low levels of lead in a supplement can have adverse effects on your children. [2] Why not use a supplement made correctly, so you can protect your family?
Here’s the Bad news from MedPage Today:
Even Low Lead Exposure Hinders Kids’ Reading
Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.
On tests of reading readiness, children with blood lead levels between 5 and 9 µg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 µg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.
And those with lead levels of 10 µg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics. [2]
Continue reading …
By Frank M. Painter, D.C. in Announcement on May 12th, 2013 at 12:11 pm
Happy Mother’s Day to all our Lady Friends!
The Chiro.Org Blog
Women are the backbone of Civilization. We honor you!
By Frank M. Painter, D.C. in Announcement on May 11th, 2013 at 12:00 am
Chiro.Org is now 18 years old! Whooo-eee!
The Chiro.Org Blog
Reach our 200,000 monthly visitors by becoming a Sponsor to support our work.
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Clinical Biomechanics: Scoliosis
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 13 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 13: Scoliosis
In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.
GENERAL CONSIDERATIONS
The Spinal Curves [1-9]
A curved column has increased resistance to compression forces. This is just as true in the spine, as for a rib or long bone. Most authorities consider the spine to have four major curves: anteriorly convex curves at the cervical and lumbar areas and, anteriorly concave curves at the thoracic and sacral levels. Cailliet considers the coccyx a curve, but this curve is usually considered an extension of the sacral curve. A few authorities consider the atlanto-occipital junction as a separate anteriorly convex curve. Regardless, the spinal curves offer the vertebral column increased inflexibility and shock-absorbing capability while still maintaining an adequate degree of stiffness and stability between vertebral segments (Fig. 13.1).
Structural vs Functional Curves
The adult thoracic and sacral anteriorly concave curves are firm structural arcs as the result of their vertebral bodies being shorter anteriorly than posteriorly. The normal kyphosis of the adult thoracic and sacral curves is quite similar to that of the fetal spine. This is not true for the anteriorly convex cervical and lumbar regions where the curves are essentially the result of their soft tissue wedge-shaped IVDs. It is for this reason that the cervical and lumbar curves readily flatten in the supine position, while the thoracic kyphosis reduces only a slight amount.
There is a clinical correlation of disc wedging to disc disease. Most disc lesions are found in the cervical and lumbar regions where the greatest degree of physiologic wedging occurs. This appears to be true in both hyperlordosis and an exceptionally flat cervical or lumbar curve.
Effect of Bipedism
An adult discless spine would resemble that of the newborn. Since animals that walk on four legs and infants prior to assuming the erect position do not have the physiologic curves of the erect adult, it can be assumed that these curves are the result of bipedism. In the erect position, the lower lumbar area is especially subjected to considerable shearing stress. [10, 11]
Overall Balance
Although the spine is often considered as the central pillar of the body, this is only true when the spine is viewed from the anterior or posterior aspect. When viewed laterally, the spine lies distinctly posterior to the thoracic body mass essentially because of the space-occupying heart (Fig. 13.2), It lies much more centrally in the cervical and lumbar regions. An abundance of body mass also lies anterior to the midline in the head, which must be held by erector and check ligament strength if a thoracic “hump” or a flattened cervical curve are to be avoided.
You may also enjoy our
Scoliosis and Chiropractic Page
Continue reading …
By John in News on May 7th, 2013 at 5:07 pm
Source The Guardian
Up to 40% of patients with chronic back pain could be cured with a course of antibiotics rather than surgery, in a medical breakthrough that one spinal surgeon says is worthy of a Nobel prize. Surgeons in the UK and elsewhere are reviewing how they treat patients with chronic back pain after scientists discovered that many of the worst cases were due to bacterial infections.
The shock finding means that scores of patients with unrelenting lower back pain will no longer face major operations but can instead be cured with courses of antibiotics costing around £114. One of the UK’s most eminent spinal surgeons said the discovery was the greatest he had witnessed in his professional life, and that its impact on medicine was worthy of a Nobel prize.
“This is vast. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics,” said Peter Hamlyn, a consultant neurological and spinal surgeon at University College London hospital.
Specialists who deal with back pain have long known that infections are sometimes to blame, but these cases were thought to be exceptional. That thinking has been overturned by scientists at the University of Southern Denmark who found that 20% to 40% of chronic lower back pain was caused by bacterial infections.
“This will not help people with normal back pain, those with acute, or sub-acute pain – only those with chronic lower back pain,” Dr Hanne Albert, of the Danish research team, told the Guardian. “These are people who live a life on the edge because they are so handicapped with pain. We are returning them to a form of normality they would never have expected.”
The Danish team describe their work in two papers published in the European Spine Journal. In the first report, they explain how bacterial infections inside slipped discs can cause painful inflammation and tiny fractures in the surrounding vertebrae.
In the second paper, the scientists proved they could cure chronic back pain with a 100-day course of antibiotics. In a randomised trial, the drugs reduced pain in 80% of patients who had suffered for more than six months and had signs of damaged vertebra under MRI scans.
By Frank M. Painter, D.C. in Chiropractic Care on April 24th, 2013 at 11:36 am
Spinal Manipulation: The Right Choice
for Relieving Low Back Pain
The Chiro.Org Blog
Spinal High-velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo
Spine 2013 (Apr 1); 38 (7): 540–548
von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med
Competence Center for Clinical Studies; and †Institute for Biometrics, University of Bremen, Bremen, Germany
Thanks to Dynamic Chiropractic for access to these Key Findings from the study
- “There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” (compared to subjects receiving diclofenac therapy).
- “Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”
- “The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation arm. While the authors note that these results were not significant due to large between-individual variations (meaning a few patients could have taken many tablets, throwing off the overall totals), it still suggests that value of spinal manipulation vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the diclofenac group).
The Abstract
Continue reading …
By John in Research on April 24th, 2013 at 11:12 am
Source The Vancouver Sun
by Dr Don Nixdorf
 Research is key to developing better treatments and care protocols to eliminate disease and stay healthy. The chiropractic profession is fortunate to have twelve Canadian Chiropractic Research Foundation (CCRF) research chairs in major universities across the country, each of which conducts and contributes to world class research. But the more significant benefits to weaving these research chairs into the fabric of academia are the interdisciplinary connections and collaborations that result. There is no other time in history where we have seen so many different health professions coming together with one common goal: improving healthcare.
When many different health professionals work together, patients routinely experience better care and are on average better prepared to care for themselves. There are several examples of this in practice already. St. Michael’s Hospital in Toronto uses a multi-disciplinary approach to treat and manage back pain. Community health clinics with nurse practitioners, dentists, nutritionists and several other health care providers are peppered throughout Canada and experience tremendous success in the amount of patients they can treat and the quality of the care that is delivered. Let’s also not forget our amazing Canadian athletes who benefit from a team healthcare approach. It makes perfect sense that patients benefit from having multiple perspectives of expertise that work together to treat the whole person, not just the corner of their body with a problem.
In an effort to gain further momentum to this type of approach and increase collaboration in the academic community, several chiropractic doctors out of McMaster University came together to form the McMaster Chiropractic Working Group in 2009. Dr. Steven Passmore DC, PhD, a researcher from the University of Manitoba is one of the founding members of this group that aims to raise the profile of chiropractic in the university setting through credible research and collaborative efforts. With the exception of the CCRF researchers in universities, chiropractic education and advancement is primarily through chiropractic schools and funded almost entirely by chiropractic doctors. Even after earning his PhD from McMaster in 2012, Dr. Passmore continues to be a part of this initiative that is setting an example for others across the country. BC is already investigating the potential of a local working group based on the McMaster model.
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By John in Chiropractic Education on April 24th, 2013 at 10:47 am
Source The Australian
Macquarie University has announced plans to offload its chiropractic teaching by 2015.
It said it would begin discussions with other “interested” higher education providers about taking over its chiropractic units and degrees, including academic staff and teaching facilities. Executive science dean Clive Baldock said his faculty wanted to concentrate on developing “recent major strategic investments” in research-intensive disciplines including biomedical science and engineering.
“Macquarie University has recently invested significantly in a postgraduate medical school and a state-of-the-art private hospital,” he said. “We naturally want to focus our efforts on supporting these initiatives with our teaching and research.” Professor Baldock issued a sales pitch to possible tenderers while acknowledging that the discipline didn’t meet Macquarie’s requirements “from a research-intensive perspective”.
“We believe our chiropractic degrees to be of the highest teaching quality, and they remain extremely popular with students,” he said.“We therefore believe the responsible thing to do is to begin discussions with other higher education providers who are keen to grow in this area.”
By Frank M. Painter, D.C. in Chiropractic Care on April 23rd, 2013 at 11:55 am
Sports Management:
Leg, Ankle, and Foot Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 27 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 27: Leg, Ankle, and Foot Injuries
The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body.
Injuries of the Leg
The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.
A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.
Bruises and Contusions
The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.
Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.
GASTROCNEMIUS CONTUSION
This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.
Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.
TRAUMATIC PHLEBITIS
Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.
Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.
NERVE CONTUSIONS
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By Frank M. Painter, D.C. in Chiropractic Care on April 20th, 2013 at 12:50 pm
Sports Management:
Shoulder Girdle Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 22 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 22: Shoulder Girdle Injuries
This chapter concerns injuries of and about the scapula, clavicle, and shoulder. In sports, the shoulder girdle is a common site of minor injury and a not infrequent site of serious disability. It is second only to the knee as a chronic site of prolonged disability. Upper limb injuries amount to about 20% of sport-related injuries. They can be highly debilitating, require considerable lost field time, and can easily ruin a promising sports career.
Introduction
The versatile shoulder girdle consists of the sternoclavicular, acromioclavicular, and glenohumeral joints, and the scapulothoracic articulation. These allow, as a whole, universal mobility by way of a shallow glenoid fossa, the joint capsule, and the suspension muscles and ligaments. The shoulder, a ball-and-socket joint, is freely movable and lacks a close connection between its articular surfaces.
The regional anatomy offers little to resist violent shoulder depression, and the shoulder tip itself has little protection from trauma. The length of the arm presents a long lever with a large head within a relatively small joint. This allows a great range of motion with little stability. The stability of the shoulder is derived entirely from its surrounding soft tissues.
History and Initial Care
A careful history recording the mechanism of trauma and the position of the limb during injury, careful inspection and palpation of the entire region, muscle and range-of-motion tests, and other standard neurologic-orthopedic tests will often arrive at an accurate diagnosis without the necessity of x-ray exposure. Forceful manipulations should always be reserved for late in the examination to evaluate contraindications.
Contusions, strains, sprains, bursitis, and neurologic deficits must be alertly recognized and treated. Fractures and dislocations, obviously, take precedence over soft-tissue injuries with the exception of severe bleeding. Always check for bony crepitus, fracture line tenderness and swelling, angulation and deformity. Because the shoulder readily “freezes” after injury, treatment must strive to maintain motion as soon as possible without encouraging recurring problems. The key to avoiding prolonged disability is early recognition and early mobilization.
There are more materials like this @ our:
Shoulder Girdle Page
Posttraumatic Assessment
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By Frank M. Painter, D.C. in Earth Day on April 19th, 2013 at 2:57 pm
How Do YOU Celebrate Earth Day?
The Chiro.Org Blog
Chiropractic Care is the most holistic and natural form(s) of treatment available.
As Stewards of Health, we can also be positive examples for our communities regarding the health challenges faced by our Planet.
If you are not already involved in activities, the Earth Day Network can connect you to local Organizations you can work with or contribute to.
Our Earth is in for a bumpy ride, and every little decision we make take can contribute to or reduce the stress on our Planet.
By Frank M. Painter, D.C. in Announcement on April 18th, 2013 at 4:19 pm
Participate in a Wellness Care/
Maintenance Care Research Project
The Chiro.Org Blog
Wellness care, or “maintenance care,” is widely accepted by the profession as an integral part of chiropractic practice. However, to date, a cause-and-effect relationship between wellness care and improved long-term health outcomes has yet to be clearly demonstrated. This proposed study is designed to add to the evidence base about this important topic.
Purpose of this Study
The purpose of this study is to assess changes in Health-Related Quality of Life over a 12 month period for chiropractic patients who do, or do not participate in wellness care. It is being conducted in the offices of U.S. chiropractors who are members of the Integrated Chiropractic Outcomes Network (ICON).
For this study, we define chiropractic wellness care as a course of long-term care provided to a patient who is either asymptomatic or whose original presenting complaint has been resolved or stabilized, and is provided for the purpose of preventing disease, optimizing function, and supporting the patient’s wellness-related activities and/or minimizing recurrences of previous complaints.
Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD, Marion Willard Evans Jr., DC, PhD, MCHES, Daniel Redwood, DC
Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 556-567
Study Design
Baseline data are collected in practitioners’ offices; follow-up is conducted by the central office at Logan, by phone and email. Each doctor enrolls 5 consecutive new patients. New patients of any age are eligible! Data are collected at 4 points: first visit and 1, 6 and 12 months later. Outcomes are assessed primarily via questions from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Patients are entered in a drawing for a $100 gift card when they complete the follow-up.
Would You Like to Join Our Study?
We have rolling enrollment so you can still join!
Simply email or call Program Coordinator
Michelle Anderson:
michelle.anderson@logan.edu or call her at: (636) 230-1946 |
Principal Investigator: Cheryl Hawk, DC, PhD
Coinvestigators: Katherine Pohlman, DC, MS, U of Alberta
Jay Greenstein, DC, CCSP, private practice
Program Coordinator: Michelle Anderson
You may also want to review our:
Maintenance Care, Wellness and Chiropractic Page
www.chirowebs.net
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